氧控制性再灌注抗犬体外循环肺缺血再灌注早期损伤  

Protective Effect of Oxygen Controlled Reperfusion on Lung Ischemic Reperfusion with Cardiopulmonary Bypass

作　　者：荣健[1] 王治平[2] 吴钟凯[2] 陈光献[2] 梁孟亚[2] 刘海[2] 

机构地区：[1]中山大学附属第一医院麻醉科,广东广州510080 [2]中山大学附属第一医院心脏外科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2009年第6期686-690,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家杰出青年科学基金(30525020)

摘　　要：【目的】探讨氧控制性再灌注(OCR)对体外循环肺缺血再灌注(I/R)早期损伤的作用。【方法】14只健康犬随机分为对照组(I/R,n=7)和实验组(OCR,n=7)。对照组全程FiO2 80%;实验组在主动脉开放即刻调整FiO2至40%,随后每5 min依次上调10%,最后达80%,其余时段均维持FiO2 80%。检测动脉血气,观察两组犬在麻醉后、主动脉开放前、开放后5、10、15、20、25 min以及停机前动脉血氧分压的变化。在开胸后即刻(T1)、主动脉开放25 min(T2)、主动脉开放90 min(T3)分别留取血液标本及肺标本。酶联免疫吸附法检测血清白介素6和肿瘤坏死因子α含量;检测肺组织干湿重比;比色法检测肺组织髓过氧化物酶活性、丙二醛含量;Western Blot检测肺组织核因子kappa B蛋白含量;光镜观察并盲法评分比较肺组织病理学变化。【结果】实验组动脉血氧分压在主动脉开放后5、10、15、20 min均明显低于对照组(P<0.05)。两组相比,实验组血清白介素6和肿瘤坏死因子α含量在T2和T3时点较对照组降低(P<0.05)。实验组肺组织干湿重比、髓过氧化物酶活性、丙二醛含量和核因子kappa B蛋白表达在T2和T3时点较对照组降低(P<0.05)。实验组肺损伤评分在T2和T3时点低于对照组(P<0.05)。【结论】氧控制性再灌注可抑制体外循环肺缺血再灌注早期炎性细胞浸润,抑制核因子kappaB蛋白表达。提示氧控制性再灌注对体外循环肺缺血再灌注早期损伤具有一定的保护作用。[Objective ] To observe the protective effects of oxygen controlled reperfusion（OCR） on lung ischemic reperfusion （I/R） with cardiopulmonary bypass（CPB）. [Methods] Fourteen canines were randomized into two groups： group I/R （ischemic reperfusion, n=7） and group OCR （oxygen controlled reperfusion, n = 7）. All animals received CPB as clinical practice. In group I/R, the animals received 80 % of the FiO2; In group OCR, the animals received 40%, 50%, 60%, 70%, and 80% of the FiO2 with CPB immediately after dectamping sequently, each oxgygen concentration lasted for 5 minutes, other procedures were the same with group I/R. Arterial blood gas was analyzed after anesthesia, before aortic declamping, 5, 10, 15, 20, and 25 min after aortic declamping. Lung tissue and blood samples were collected at T1 （just after sternotomy）, T2 （25 min after aortic deelamping）, and T3 （before weaning off ）. The level of IL-6 and TNF-α in serum, the dry/wet weight （D/W） of the lung tissues, the level of MPO activity and MDA in the lung tissue, NF-kB expressions and pathological changes of the lung tissues were examined. The level of IL-6 and TNF-α, MPO activity and MDA, the expression of NF-kB were measured by enzyme-linked-immunosorbent assay （ELISA）, colorimetry and western blot as intrgrated optic density, respectively. Pathological changes of the lung tissue were examined and scored with light microscope. [Results] Arterial oxygen pressure （PaO2） was significantly lower in the OCR group at 5, 10, 15, and 20 rain after aortic declamping （P 〈 0.05）. IL-6 and TNF-α levels in serum in OCR group at T2 and T3 were significantly lower than those in I/R group. D/W, MPO activity, MDA levels and NF- κB expression in the lung tissues in OCR group at T2 and T3 were significantly lower than those in I/R group （P 〈 0.05）. Pathological scores in OCR group at T2 and T3 were significantly lower than those in I/R group （P 〈 0.05）. [Conclusion] Oxygen controlled reperfusion can inhibit

关 键 词：氧控制性再灌注 体外循环肺缺血再灌注损伤 白细胞介素6 肿瘤坏死因子Α 肺干湿比 髓过氧化物 酶 丙二醛 核因子KAPPA B 

分 类 号：R654.1[医药卫生—外科学]